Sleep problems: what helps and when to get help

What counts as insomnia?

The NHS says a person who regularly finds it hard to fall asleep, stay asleep or wake up too early may have insomnia. It also says insomnia usually gets better by changing sleeping habits.

A primary care pathway from NHS South Yorkshire advises considering life events and physical or mental health problems as possible triggers of insomnia. Primary care guidance for GPs in the NHS lists physical conditions such as sleep apnoea among the possible causes of insomnia. It also suggests that a clinician asks whether a medicine could be a cause, and considers anxiety or depression as possible underlying factors.

Which sleep habits do NHS pages describe?

The NHS Every Mind Matters pages say a regular sleep routine can make it easier to fall asleep, because going to bed and getting up at similar times each day helps the body know when it is time to sleep. They suggest keeping the same routine on days off. They also suggest keeping phones, tablets and computers away for an hour before bed, because the light can delay sleep. Reading, meditation or breathing exercises are given as alternatives.

A dark, quiet and cool bedroom is a recurring recommendation across NHS pages. NHS pages also advise against caffeine, smoking and alcohol in the hours before bed, although the exact timing differs from page to page. Some pages advise against napping during the day and describe regular daytime exercise as helpful. For someone who worries in bed, the NHS suggests writing a list of tasks for the next day before going to sleep.

What does the NHS suggest when sleep will not come?

If a person is still awake after about 20 minutes, the NHS suggests getting up, doing something relaxing in another room, and going back to bed when sleepy.

When does the NHS suggest seeing a GP?

The NHS suggests seeing a GP if changing sleeping habits has not helped insomnia, or if there has been trouble sleeping for months. A GP may refer a person for cognitive behavioural therapy, or CBT, which helps change the thoughts and behaviours that get in the way of sleep. The NHS says GPs now rarely prescribe sleeping pills for insomnia, because they can have serious side effects and a person can become dependent on them.

What does CBT for insomnia involve?

The NHS recommends cognitive behavioural therapy for insomnia, known as CBT-I, as the first treatment for insomnia. CBT-I can be delivered in person, in groups or online, for example through the Sleepio programme, which is designed to be completed over six weeks; availability and cost to the patient vary by area. A primary care guideline from Buckinghamshire, Oxfordshire and Berkshire West advises that medicines are best avoided in the long-term management of insomnia.

How much sleep do adults need, and why does it matter?

NHS sources put the amount most adults need at about 7 to 9 hours a night. One NHS page says age, health and daily routine can all affect how much sleep a person needs. NHS Every Mind Matters says getting enough sleep can support mood, energy, the immune system and overall health. A United States guide from the National Heart, Lung, and Blood Institute adds that regularly getting too little or very poor quality sleep increases the risk of high blood pressure, heart disease and other health problems. NHS pages list feeling very tired, irritable or sleepy during the day among the signs of not sleeping enough.

Could another sleep disorder be involved?

The NHS says a person may be referred to a sleep clinic if they have symptoms of another sleep disorder, such as sleep apnoea.